Individual provider · Type 1 NPI
Mark Theodore, FNP-BC
Family Nurse Practitioner · Utica, NY
NPI number
1457793135
Active
Practice location
1656 Champlin Ave
Utica, NY 13502-4830
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Critical Care Medicine Registered Nurse | 163WC0200X | 629932 (NY) |
| Family Nurse Practitioner Primary | 363LF0000X | 338083 (NY) |
Family Nurse Practitioner: Definition to come...
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About NPI 1457793135
Mark Theodore, FNP-BC's National Provider Identifier is 1457793135, issued on Jul 23, 2013. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Utica, NY. The record was last updated on Jul 23, 2013.